A predictive model of anxiety and depression symptoms after a lower limb amputation

Patients with Diabetic Foot Ulcer (DFU) show high levels of depression and anxiety symptoms. The loss of a limb is undoubtedly a devastating experience and several studies have shown that anxiety and depression symptoms are a common reaction after a lower limb amputation (LLA). However, no study has focused on the immediate emotional reactions to LLA as a personal factor based on the ICF Model. Objective: This study focused on the characterization of anxiety and depression levels, before and after surgery, differences in levels of depression and anxiety before and after surgery and the predictors of anxiety and depression one month after surgery, in a sample of patients with DFU. Methods: This was a longitudinal study with 179 patients with Diabetes Mellitus Type 2 and DFU indicated for amputation, screened for the presence of anxiety and depression symptoms during the hospitalization that preceded amputation and one month after surgery, during a follow-up consultation. Results: The results showed a significant effect of anxiety and depression symptoms at pre-surgery in the prediction of anxiety and depression symptoms one month after LLA. Patients showed higher levels of anxiety than depression symptoms at pre-surgery, although anxiety significantly decreased on month after surgery. Both anxiety and depression symptoms contributed to depression after LLA, although anxiety at pre-surgery was the only predictor of anxiety at post-surgery. Conclusions: Tailored multidisciplinary interventions need to be developed providing support before and after an amputation surgery, in order to reduce anxiety and depression symptoms and promote psychological adjustment to limb loss.POCI-01-0145-FEDER-007653. Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds and cofinanced by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653). This work was supported by a grant (SFRH/BD/87704/2012) from the Portuguese Foundation for Science and Technolog

Predictors of quality of life in patients with diabetic foot ulcer: The role of anxiety, depression, and functionality

The goal of this study was to analyze the relationships between anxiety, depression symptoms, and functionality as predictors of quality of life, in patients with diabetic foot ulcer taking in consideration clinical variables. A sample of 202 participants indicated for a lower limb amputation surgery, were assessed before the surgery, on physical and mental quality of life, functionality, a anxiety and depression symptoms. Anxiety and depression symptoms, as well as functionality level were predictors of mental quality of life. Pain, having a first amputation, depression symptoms, and functionality were predictors of physical quality of life. In order to promote quality of life, psychological variables should be targeted, in clinical practice.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was conducted at Psychology Research Centre (PSI/01662), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653). This work was supported by a grant (SFRH/BD/87704/2012) from the Portuguese Foundation for Science and Technology

Influence of a heat-shock pre-treatment on wound-induced phenolic biosynthesis as an alternative strategy towards fresh-cut carrot processing

In fresh-cut vegetables, plant tissues are often challenged by (a)biotic stresses that act in combination, and the response to combinatorial stresses differs from that triggered by each individually. Phenolic induction by wounding is a known response contributing to increase products phenolic content. Heat application is a promising treatment in minimal processing, and its interference on the wound-induced response is produce-dependent. In carrot, two-combined stress effects were evaluated: peel removal vs. shredding, and heat application (100 C/45 s) vs. shredding, on changes in total phenolic content (TPC) during 10 days (5 C). By applying the first stress combination, a decrease in TPC was verified on day 0 ( 50%), ascribed to the high phenolic content of peels. Recovery of initial fresh carrot levels was achieved after 7 days owing to phenolic biosynthesis induced by shredding. For the second combination, changes in TPC, phenylalanine-ammonia-lyase (PAL), and peroxidase (POD) activity of untreated (Ctr) and heat-treated (HS) peeled shredded carrot samples were evaluated during 10 days. The heat-shock did not suppress phenolic biosynthesis promoted by PAL, although there was a two-day delay in TPC increments. Notwithstanding, phenolic accumulation after 10 days exceeded raw material TPC content. Also, the decrease in POD activity (30%) could influence quality degradation during storageinfo:eu-repo/semantics/publishedVersio

Quality of life of women with urinary incontinence in rehabilitation treatment

This article analyzed how sexual satisfaction, suffering, severity and impact of urinary incontinence, and psychological morbidity affected women's quality of life and whether suffering mediated the relationship between psychological morbidity and quality of life. The study included 80 women diagnosed with urinary incontinence receiving rehabilitation treatment. Regression analysis showed that sexual satisfaction, suffering, and urinary incontinence severity and impact predicted quality of life and that suffering mediated the relationship between psychological morbidity and quality of life. The findings suggest that interventions should be tailored according to the suffering reported by women and the impact of the urinary incontinence on the couple's sexual relationship.(undefined

Psychosocial adjustment to a lower limb amputation ten months after surgery

Objective: This longitudinal multisite study examined the influence of demographic characteristics psychological reactions, functionality coping strategies, and social support on psychosocial adjustment to lower limb amputation 10 months after suigery. Method: Of an initial referral of 206 Portuguese patients, a sample of 86 patients who underwent a lower limb amputation due to Diabetes Mellitus Type II were evaluated during the hospitalization that preceded surgery (t0) and at inpatient follow-up consultations, 1 (tl) 6 (t2), and 10 months (t3) after surgery. Results: Higher levels of anxiety symptoms and functionality at presurgery were associated with lower social adjustment to amputation and with higher adjustment to the limitations (t3) respectively. Traumatic stress symptoms (tl) were negatively associated with general and social adjustment, and with the adjustment to the limitations (t3). Perceived social support (t2) mediated the relationship between traumatic stress symptoms (tl) and adjustment to the limitations (t3). Male gender was associated with a higher anxiety and depression symptoms (t0) and with a higher level of functionality (tl). Male gender was associated with functionality at presurgery and postsurgery, and with anxiety and depression symptoms of presurgery. Implications: Results support the need to improve psychological screening and early treatment of anxiety symptoms before the surgery, as well a.s depression and traumatic stress symptoms after a lower limb amputation, and the promotion of social support over time, in order to promote psychosocial adjustment to amputation. This set of psychosocial variables should be included when planning postamputation rehabilitation and psychosocial intervention programs for this target population.- This study was conducted at the Psychology Research Center (PSI/01662), University of Minho, and supported by the Portuguese Ministry of Science, Technology and Higher Education through national funds and cofinanced by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653) and by a grant (SFRH/BD/87704/2012) from the Portuguese Foundation for Science and Technology. The authors gratefully acknowledge the contributions of the Multidisciplinary Diabetic Foot Clinics of the following hospitals: CHP, CHSJ, CHVNG/E, CHTS, ULSAM, and the Vascular Surgery Departments in Braga and CHSJ Hospitals. The authors also wish to thank all patients who agreed to participate in this study

Self-reported adherence to foot care in type 2 diabetes patients: do illness representations and distress matter?

Aim: This study examined the differences and the predictive role of clinical variables, illness representations, anxiety, and depression symptoms, on self-reported foot care adherence, in patients recently diagnosed with type 2 diabetes mellitus (T2DM) and assessed no longer than a year after the diagnosis (T1) and four months later (T2). Background: The high rate of diabetes worldwide is one of the major public health challenges. Foot care is the behavior least performed by patients although regular foot care could prevent complications such as diabetic foot and amputation. Psychosocial processes such as illness representations and distress symptoms may contribute to explain adherence to foot self-care behaviors. Methods: This is a longitudinal study with two assessment moments. The sample included 271 patients, who answered the Revised Summary of Diabetes Self-Care Activities, Brief-Illness Perception Questionnaire, and Hospital Anxiety and Depression Scale. Findings: Patients reported better foot care adherence at T2. Having a higher duration of T2DM and the perception of more consequences of diabetes were associated with better self-reported foot care adherence, at T1. At T2, the predictors were lower levels of HbA1c, better self-reported foot care adherence at T1, higher comprehension about T2DM, as well as fewer depressive symptoms. Interventions to promote adherence to foot care should have in consideration these variables. The results of the present study may help health professionals in designing interventions that early detect depressive symptoms and address illness beliefs, in order to promote foot self-care behaviors reducing the incidence of future complications.This study is the part of a research project PTDC/SAUESA/67581/2006 supported by the Foundation for Science and Technology of Portugal (FCT)

Influence of postharvest ultrasounds treatments on tomato (Solanum lycopersicum, cv. Zinac) quality and microbial load during storage

Whole tomato fruits were treated at ultrasonic power levels from 10% to 100%, and at a constant frequency of 45 kHz, for different times (1-19 min). A central composite rotatable design (CCRD) was applied to optimise ultrasonic treatments for tomato quality (colour, texture and total phenolic content (TPC)) maintenance. According to response surface analysis, the optimal treatment parameters were 55%_10 min, 80%_15 min and 100%_19 min. At these conditions, and especially at higher power levels, a maximum retention of colour and texture, as well as an increase of TPC and microbial reduction were obtained in comparison with untreated fruits during 15 storage days at 10 degrees C. The ultrasounds treatment was found to be effective in delaying colour development and texture losses, preserving sensorial quality of whole tomato, with increase of TPC and microbial load reduction. Moreover, this postharvest treatment can be used as an alternative for extending fresh fruits shelf-life.info:eu-repo/semantics/publishedVersio

Quality changes during thermal processing of two mixed formulas of fruits and vegetables pulps

Research ArticleThe present work aimed to evaluate, through thermal degradation kinetics (80 °C to 98 °C in time intervals of 0.5 to 25 min), the effects of different thermal treatments on the biochemical, physicochemical, sensory and microbiological parameters of two mixed fruit and vegetable pulps, a yellow and a red one. The evaluated fruit and vegetable pulps resulted from the mixture of different fruits and vegetables proportions (pineapple, beetroot, strawberry and lemon juice) added to a 50% (p/p) pear-based pulp to maximize their bioactivity, physicochemical stability and sensorial acceptance. Evaluated quality parameters included the determination of peroxidase activity (POD), pH, soluble solids content (SSC), total phenolic content (TPC), CIELab colour, sensory evaluation (colour, taste and aroma) and total mesophilic aerobic counts (TAPC). Regarding heat treatments optimization for both pulps with lower pH, it was concluded that higher temperature treatments (90 to 98 °C) applied over a shorter time (less than 5 min) were more effective to inactivate POD, to reduce the initial microbial load (>2 log10 cycles) and to maximize sensorial attributes. In both mix pulps, total phenolic content (TPC) was not significantly influenced by the different applied time-temperature binomials. From the degradation kinetic models and as an example, it was possible to conclude that POD followed a 1st order kinetic, where the temperature effect was well fitted to the Arrhenius equation. The results allowed to obtain optimized time-temperature binomials for each pulp to simultaneously achieve POD enzyme inactivation, microbial reduction, and maximization of quality parameters relatively to fresh pulps, 90 °C/5 min and 98 °C/2.5 min, for the yellow pulp and red pulp, respectivelyinfo:eu-repo/semantics/publishedVersio

Satisfaction with life in individuals with a lower limb amputation: The importance of active coping and acceptance

The aim of this study was to analyze the relationship between sociodemographic/clinical characteristics, coping strategies and satisfaction with life in individuals with lower limb amputation. Sixty-three individuals with a lower limb amputation due to Diabetes and Peripheral Vascular Disease participated in the study and answered measures of coping strategies and satisfaction with life. Findings revealed high dissatisfaction with life. Acceptance and active coping were the most used coping strategies. Satisfaction with life was positively associated with active and planning coping, religion, acceptance and humour. There were differences in coping strategies according to gender, age, marital status, presence of residual limb pain, prosthesis use and mobility level. Results emphasize the differential role of coping strategies, for each individual. Psychosocial interventions need to take into consideration coping strategies during the process of rehabilitation and be specific regarding individuals` sociodemographic and clinical characteristics. This study may help design interventions that answer individuals with lower limb amputations given that coping strategies are a valuable resource in the promotion of satisfaction with life.- (undefined

Quality of life in elderly Portuguese war veterans with post-traumatic stress symptoms

Studies show that post-traumatic stress symptoms among Portuguese veterans who participated in Colonial War (1961-75) are high, even though 43 years have gone by since the end of the war.Background: Studies show that post-traumatic stress symptoms among Portuguese veterans who participated in Colonial War (1961-75) are high, even though 43 years have gone by since the end of the war.Aims: This study analyzed the role of family type, personality traits, and social support as predictors of post-traumatic stress symptoms and quality of life in war veterans, and whether satisfaction with social support was a mediator between neuroticism/post-traumatic stress symptoms and quality of life.Method: A cross-sectional study was conducted including 230 war veterans with a mean age of 60 years (SD=3.82).Results: Results indicated a high prevalence of post-traumatic stress symptoms as well as high neuroticism, 16.5 (SD=4.41); 81% of veterans presented high psychological distress, suggesting emotional disturbance and 71% belonged to extreme families (families with cohesion and adaptability problems). Results showed that age (beta=-0.166, p<0.05), social support (beta=-0.184, p<0.01), and neuroticism (beta=0.325, p<0.001) predicted post-traumatic stress symptoms. Age, professional status, social support, post-traumatic stress symptoms, family type, neuroticism, and extroversion predicted different dimensions of quality of life. Finally, a path analysis showed that satisfaction with social support was a mediator in the relationship between neuroticism and quality of life (beta=-0.066; p<0.01) and between post-traumatic stress symptoms and quality of life (beta=-0.108; p<0.01).Conclusion: Four decades after the Colonial War have passed, there is still a high prevalence of post-traumatic stress symptoms. Screening elderly veterans who present post-traumatic stress symptoms, for the presence of neuroticism traits, and assessing family type and social support, should be a standard practice in health care services, especially in the oldest and those who are retired. Social support should be promoted in order to enhance quality of life in this population